Antilymphoblast globulin for treatment of acute renal allograft rejection
Steven B. Streem, M.D.
Department of Urology
Andrew C. Novick, M.D.
Department of Urology
William E. Braun, M.D.
Department of Hypertension and Nephrology, Department of Immunopathology
Donald R. Steinmuller, M.D.
Department of Hypertension and Nephrology
The role of heterologous antilymphocyte globulin (ALG or ATG) in clinical renal transplantation remains controversial. There have been conflicting reports on the efficacy of various ALG preparations administered prophylactically from the time of transplantation.1–5 More recently, ALG has been used to treat acute renal allograft rejection; most reports have described its use in combination with high-dose steroids.6–10 Two studies have suggested that ALG can successfully reverse steroid-resistant rejection episodes.11, 12 One study of living-related graft recipients, in which ATG was used as the sole adjunctive measure to treat rejection, demonstrated both an immunologically beneficial and steroid-sparing effect.13 We report our initial experience with antilymphoblast globulin used to treat acute rejection in 30 renal-transplant recipients. In 24 patients, ALG was used alone without high-dose steroid administration as specific therapy for an acute rejection episode. In 6 patients, ALG was given as treatment for steroid-resistant rejection.
Materials and methods
The 30 patients in this study underwent renal transplantation between May 1980 and August 1981. The post-transplant follow-up interval ranged from 5 to 20 months. There were 4 living-related and 26 cadaver-graft recipients. Twenty-nine patients (97%) had received ≥ 2 blood transfusions before transplantation. As maintenance immunosuppression all recipients were given azathioprine, 3–5 mg/kg in the 12 hours before transplantation and were then maintained on 1.5–2.0 mg/kg/day. One gram of methylprednisolone was administered intravenously in divided doses on the day of surgery. All living-related and alternate cadaver-graft recipients were given prednisone, 2 mg/kg/day (high maintenance steroid) from the first . . .